Using Cameroon’s Community Grapevine to Prevent Mother-to-Child Transmission

YAOUNDE, Aug 3 2012 (IPS) - For nearly two years, not a single child with HIV has been born at the public hospital in the Cité-Verte district of Yaoundé, the capital of Cameroon. Dr Emilien Fouda, the hospital’s director, says this proud record is the result of combined effort by his staff and community support groups.

Philomène Manga had an HIV test in 2005. She was four months pregnant. “When I told my husband that the test result came back positive, he asked me to have an abortion rather than give birth to a sick child,” Manga told IPS.

But thanks to advice from a community group called the No Limit for Women Project (NOLFOWOP), she decided to keep the baby.

“I got medical treatment so that my child didn’t get HIV. Today I have two healthy children, one aged six and the other two and a half. And I’m thinking about having a third,” said Manga.

The steps involved in prevention of mother-to-child transmission (PMTCT) are well known: “The PMTCT programme includes awareness-raising, voluntary – and confidential – screening for HIV, testing for other sexually transmitted infections, and birthing practices that minimise the risk of HIV transmission,” Fouda told IPS. “We also provide sero-positive women and children with antiretrovirals and psychosocial support, as well as advice on feeding.”

The doctor said the Cité-Verte hospital staff tell women how a mother can avoid passing HIV on to her child during pre-natal checkups.

“But the first step is an HIV test,” Fouda told IPS.

And this is where the first complication creeps in. According to a report by the government’s National Committee for the Fight Against AIDS, published in March 2012, roughly one in five women who attend prenatal checkups refuse an HIV test.

Fouda said the government has had to take steps so that women who decline testing don’t end up giving birth to children with the virus. “We have firm instructions. In the birthing room, we systematically screen all women whose HIV status is unknown and immediately administer PMTCT if necessary,” he said.

According to statistics published in June 2012 by UNICEF’s Cameroon office, 20 percent of the country’s cases of mother-to-child transmission of HIV occur during pregnancy, 65 percent at the moment of birth, and 15 percent during breastfeeding. The rate of HIV among pregnant women in this Central African country is 7.6 percent.

The intervention in the labour ward is crucial, but this leaves a still larger challenge unanswered: by UNICEF’s calculations, roughly a million women should have come in for a prenatal checkup in 2011, but only 364,000 actually did so. And when it comes time to give birth, many women go to private clinics or small birthing centres in poor areas.

With nearly two-thirds of pregnant women staying away from public health centres, the efforts of community support groups becomes even more important in preventing mother-to-child transmission.

This is where the work of groups like No Limit For Women is vital. NOLFOWOP, an association of women living with HIV, was established in 2000. The group’s members meet with health workers at the Cité-Verte hospital twice a week, and take the message of PMTCT out to women in the surrounding community.

“We try to reach as many women as possible by taking part in meetings of various women’s associations. We urge these women to go to public hospitals and stay in touch with them by means of home visits,” said Odette Etamè, president of NOLFOWOP.

This pro-active awareness-raising in the community also helps to reach women who know their HIV-positive status and want to have children but have concerns.

“Thanks to PMTCT, I have a two-year old son who is sero-negative,” said Martiale T., a 32-year-old living with HIV.

Etamè’s association enjoys support from several institutions, including the national health ministry, Care International and UNICEF. The financial support goes towards costs such as transport for members making home visits.

But if things are going well in Cité-Verte, many gaps remain in nationwide PMTCT coverage. Community support groups like NOLFOWOP are only present at some of the country’s hospitals, and not all public health centres systematically test women giving birth, for HIV.

But Etamè said the model in practice at Cité-Verte should be extended across the country.

“The plan is to create at least one community support group in each of Cameroon’s 179 health districts. This is already under way in some districts, but it is not yet in effect everywhere,” she said.